"I think we still do too little": measures to prevent violence and aggression in German emergency departments - a qualitative study.

BACKGROUND: Healthcare workers employed in emergency departments (EDs) are particularly affected by physical and verbal violence. Violent assaults can be committed by both patients and their attendants. Research on interventions for violence prevention is limited and previous studies report that ED employees feel unprepared for violent incidents. Thus, the current study aims to explore ED staff's perceptions regarding available prevention measures, their effectiveness, barriers, and further needs in terms of violence prevention. METHODS: In accordance with the qualitative study design, 27 semi-structured interviews were conducted via telephone with doctors and nurses working in direct contact with patients in German EDs. Main subjects were advantages and disadvantages of currently available measures, barriers regarding their implementation, their perceived effectiveness, as well as further needs concerning violence prevention. The transcribed interviews were analysed according to Mayring's qualitative content analysis. RESULTS: Participants described environmental (e.g., alarm systems), organisational (e.g., security service), and individual-focused measures (staff training, verbal de-escalation). Measures perceived as effective were, for instance, communication and security service. Both demands and barriers were often related to financial constraints, e.g., staff shortage led to higher workloads and less time to consider violence prevention. In most cases, guidelines or standard operating procedures (SOPs) regarding violence prevention were missing, unknown, or not perceived as helpful in their current form. Furthermore, screening tools were not applied in any of the EDs. CONCLUSIONS: The workload in EDs needs to be decreased in order to enable violence prevention, e.g., by reducing patient inflow or by increasing personnel. In addition, violence prevention guidelines tailored to the requirements of the respective ED need to be developed. Hospitals should supply ED staff with such guidelines, e.g., in the form of SOPs, but more importantly, prevention measures have to be practiced and communicated. Furthermore, there is a need for research on the implementation of screening tools for violent behaviour, so that the focus would shift from managing violence to preventing violence.

Exploring job demands and resources in psychotherapists treating displaced people-A scoping review.

Objective: Little is known about the occupational health of psychotherapists treating displaced people. Therefore, the literature was explored regarding job demands, job resources, as well as work- and health-related outcomes. The Job Demands-Job Resources model (JD-R model) according to Bakker and Demerouti served as theoretical framework. Method: This scoping review followed the methodological framework provided by the Joanna Briggs Institute (JBI). Six databases were searched for qualitative, quantitative and mixed methods studies. Results: Based on 15 included articles, the emotional impact of work, cultural or language barriers, and administrative obstacles were identified as major job demands. Important job resources were related to a politicized conceptualization of the professional identity. Health-related outcomes could mainly be ascribed to empathy-based strain, while work-related outcomes were associated with discrepancies between personal values and asylum regulations. Conclusion: Despite the emotional impact of work, psychotherapists seem to benefit from work engagement arising out of socio-political conviction and the ability to help suffering people. Practitioners need more environmental support like professional networks. Further research is required, as current findings are predominantly based on qualitative and cross-sectional studies.

Violence Prevention Climate and Health-Oriented Leadership in German Emergency Departments.

Emergency departments (EDs) are high-risk environments for workplace violence. Research into techniques to prevent violence has less frequently explored the influence of leadership. This study aims to analyze the association of leadership with the prevention of violence using the concepts of health-oriented leadership (HoL) and the violence prevention climate (VPC). This quantitative cross-sectional study was conducted through online surveys between November 2021 and March 2022 across Germany. A sample of 370 doctors and nurses working in German EDs were recruited. Perceptions towards VPC and HoL were compared between groups divided according to profession and position using independent t-tests or Mann-Whitney U tests. Separate multiple linear regression models for supervisors and employees analyzed the association between different profiles of HoL with VPC. Supervisors and employees showed significant differences in supervisor staff-care and VPC. Regression analysis demonstrated that supervisors' self-care and employees' assessment of supervisor's staff-care positively predicted all dimensions of VPC. This empirical study provides insights into the variable perceptions of different groups and the association of leadership profiles with the perceptivity of VPC. The results of this study can be used to emphasize the importance of HoL training for both employees and supervisors to improve communication and health-promoting behavior.

[Emergency care as a high-risk workplace-Measures to deal with violence against employees]. / Notfallversorgung als risikoreicher Arbeitsplatz ­ Maßnahmen zum Umgang mit Gewalt gegen Beschäftigte.

BACKGROUND: Many employees in the field of emergency care experience verbal and physical violence caused by patients or visitors. The aim of this project is to gain insights into which measures are available to deal with violence in emergency care and how employees subjectively evaluate them. METHODS: A nationwide cross-sectional online survey was conducted in 2020. The questionnaire contained items on violence prevention, intervention, and follow-up measures. Quantitative data were analysed descriptively and free text data according to Mayring's qualitative content analysis. RESULTS: A total of 349 respondents, including 115 supervisors participated in the survey. The availability of security staff and standardised reporting of incidents were considered important measures for dealing with violence. Of the managers, 67% reported not having a security service, while 56% claimed that reported incidents of violence were not dealt with in a structured way. A high workload in emergency care can impede the implementation of measures. Overall, the demand for increased support by supervisors and the hospital management became clear. CONCLUSION: It is evident that employees consider certain measures to be effective; however, these measures are often not consistently implemented. There is a need for structured reporting of violent incidents against employees to facilitate a realistic recording of the prevalence. In addition to increasing the (nursing) staff, restricting access for visitors can decrease the conflict potential.